Launch of the Knowledge Hub on Health and Migration

Dr Zsuzsanna JakabWHO Regional Director for Europe

15 November 2016, Palermo, Italy

Close collaboration between WHO/Europe, Italy and Sicily Region

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Assessment missions

Contingency planning

Panorama case study

2011 2012 2014

Close collaboration between WHO/Europe, Italy and Sicily Region

Workshop for toolkit consultation

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The Knowledge Hub on Health and Migration

Migration and health multi-stakeholder

knowledge sharing platform

Scientific and capacity-building forum

Aim:Improve public policies and interventions to address the

health needs of migrants and the public health implications of migration in the WHO European Region

The Knowledge Hub

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Collaboration and interaction between health and non-health sectors

Gather good practices, experiences, evidence-based approaches

Iimproving countries’ preparedness

Promoting people-centred health

systems

Reducing health inequalities

Looking forward to a good collaboration with Sicily

• Similar to the extensive and close collaboration with Italy

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Extensive collaboration with Italy over decades

• Member of WHO Governing Bodies• SCRC now

• EB from 2017

• Pan-European conference in Rome in November 2015 on migration and health – migration/health strategy

• 2018: Italy hosts the Regional Committee for Europe

Life expectancy trends in ItalyLife expectancy at birth (years), males Life expectancy at birth (years), females

70

75

80

85

1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy

Source: WHO/Europe: European Health for All database

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Proportion of population aged 65 and over and birth rate

% of population aged 65+ years Live births per 1000 population

8

12

16

20

1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy

Source: WHO/Europe: European Health for All database

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Mortality by broad cause, all ages

SDR, Infectious and parasiticdiseases, per 100000 SDR, Neoplasms, per 100000 SDR, Diseases of the circulatory

system, per 100000

SDR, Diseases of the respiratorysystem, per 100000

SDR, Diseases of the digestivesystem, per 100000

SDR, External causes of injury andpoisoning, per 100000

5

10

15

20

160

200

240

100

200

300

400

500

50

100

150

20

30

40

50

60

20

40

60

80

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy

Source: WHO/Europe: Mortality indicator database

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Premature mortality(064 years), by broad cause

SDR(0-64), Infectious and parasiticdiseases, per 100000 SDR(0-64), Neoplasms, per 100000 SDR(0-64), Diseases of the

circulatory system, per 100000

SDR(0-64), Diseases of therespiratory system, per 100000

SDR(0-64), Diseases of the digestivesystem, per 100000

SDR(0-64), External causes of injuryand poisoning, per 100000

5

10

15

60

80

100

50

100

10

20

30

10

20

30

25

50

75

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy Source: WHO/Europe: Mortality indicator database

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Health situation in Sicily – comparison with the European Region

Infant mortality, life expectancy and all-cause mortality in Sicily and comparison with EU regions,

around year 2013

Indicator Sicily Comparison with EU regions (quintiles)

(2010)

Infant mortality rate (deaths per 1000 live births)

4.14

Life expectancy at birth – females (years) 83.4

Life expectancy at birth – males (years) 79.0

WHO/Europe: Equity in health project – interactive atlases, http://data.euro.who.int/equity

All-cause and amenable mortality in Sicily and comparison with EU regions, around year 2013

Indicator Sicily Comparison with EU regions (quintiles)

Age standardized death rate (ASDR) per 100 000 population, all causes, all ages, females

705.2

ASDR per 100 000 population, all causes, all ages, males 1038.3

ASDR per 100 000 population, all causes, all ages, both sexes 967.8

ASDR per 100 000 population, amenable causes, 2064, both sexes 116.75

WHO/Europe: Equity in health project – interactive atlases, http://data.euro.who.int/equity

Causes of amenable death Standardized death rate by residence 2013 (all ages)

GEO/SEX

Malignant neoplasm of colon, rectosigmoid junction, rectum, anus and anal canal

Malignant neoplasm of liver and intrahepatic bile ducts

Malignant neoplasm of trachea, bronchus and lung

Alzheimer disease

Ischaemic heart diseases

Acute myocardial infarction including subs. myocardial infarction

Cerebrovascular diseases

Asthma and status asthmaticus BPCO

Malignant neoplasm of breast (Females)

Malignant neoplasm of cervix uteri (Females)

European Union (28 countries) 31.29 10.51 55.15 17.83 131.87 50.08 88.68 1.38 33.52 33.19 4.03Italy 27.75 14.57 50.51 14.52 104.16 37.94 84.11 0.64 28.87 31.63 1.23Sicily 29.06 13.59 46.56 15.19 103.83 38.20 115.42 0.60 6.77 29.91 1.27

Availability of hospital beds and human resources for health in Sicily and comparison with EU regions, around year 2013

Indicator Sicily Comparison with EU regions (quintiles) 2010

Hospital beds per 100 000 inhabitants 470.3

Physicians per 100 000 inhabitants* 705.5

WHO/Europe: Equity in health project – interactive atlases http://data.euro.who.int/equity

Social gradient in Italy – disposable household income and life expectancy, around 2010

Social gradient in Italy – disposable household income and amenable mortality, around 2010

Social gradient in Italy – long-term unemployment and amenable mortality,

around 2010

Social gradient in Italy – long-term unemployment and premature mortality (064 years) from ischaemic heart

disease among males, around 2010

Summary of findings• Infant mortality in Sicily is high, in the highest quintile of the EU regions.• Life expectancy in Sicily is close to the average of all EU regions and is the

second lowest in Italy.• Inequalities in social determinants like disposable income and long-term

unemployment are large between Italian regions.• In Italy, the difference between the regions with highest and lowest life

expectancy is 2.5 years;• Sicily has one of the highest densities of physicians in the EU, but the

availability of nurses and hospital beds is below average;• There is considerable inequality at regional level in Italy, and health

outcomes like life expectancy and amenable mortality show strong correlation with social determinants.

Sicily: facts and figures on migration

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Migrants arriving in Sicily through the Mediterranean Sea

Foreign citizens living in Sicily and their origin

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Maximum value

Regional average

Minimum value

Situation in Europe:Inequalities in life expectancy: declining, but gap persists

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Maximum value

Regional average

Minimum value

Situation in Europe:Inequalities in life expectancy: declining, but gap persists

Health equity and determinants at the heart of Health 2020

Lifestyle, social, economic and environmental determinants of health

Health equity

Good governance

Towards a roadmap for implementation of the SDGs in the European Region

PARTNERSHIPS

Agenda 2030:Health is central to development

Health and well-being arean outcome,

a determinant and an enabler

of the 17 SDGs

PARTNERSHIPS

Speaking one languageHEALTH DISCOURSE DEVELOPMENT DISCOURSE

Health equity Leave no one behindSocial, economic and environmental determinants Social, economic and environmental dimensionsEmpowerment Empowered peopleResilient communitiesLife courseRights- and gender-based Rights- and gender-basedWhole-of-societyWhole-of-governmentHealth in all policies Health in all SDGs

Good governance and peace-building

Resilient nations

We are on track towards a healthier Europe

Premature mortalityLife expectancy

Yet challenges remain

The early years and childhood Health inequities have a strong association with material conditions and experiences

Source: Life Gets Under Your Skin, International Centre for Life course Studies in Society and Health (ICLS), 2012

• Low birth weight• Not being breastfed• Maternal depression• Having a lone parent• Median family

income <60% of average

• Parental unemployment

• Maternal qualifications

• Damp housing• Social housing• Area deprivation

Gender inequity: longer life expectancy for women but more years in poor health

Global Health Observatory (GHO) data [online database]. Geneva: World Health Organization; 2016 (http:// www.who.int/gho/en/, accessed 20 July 2016)

Geographic inequities Life expectancy at birth in EU NUTS 2 regions, 2007–2009

The working years• Long durations of involuntary unemployment (three or more years)

in young men significantly predict heavy drinking and more frequent drinking at ages 2735 years.

• Those who experienced long-term unemployment before the age of 33 are more likely to report risky health behaviours than those who had not experienced unemployment, including those from more advantaged backgrounds.

• Poor mental health is more prevalent among workers with non-fixed temporary employment and those without contracts than among workers with permanent or fixed temporary employment contracts.

• There is a 50% increased risk of fatal and non-fatal cardiovascular events in those experiencing work-related stressors and this follows a social gradient.

• There is a positive association between unemployment and hospitalization for all causes in the Belgian provinces. • There is a strong association between long-term unemployment and hospitalization for cerebrovascular disease in adult males.

Unemployment as a risk for NCDs

Belgian provinces with higher unemployment rates = higher illness rates

Equity in health project – correlation map atlas, WHO/Europe 2012

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Increasing European and international attention on reducing inequities

Income inequalities

Employment & educational inequalities

Health inequities

Good governance for equitable development

A joint monitoring framework forHealth 2020, NCDs and SDGs

AlcoholEducational attainment

Health expenditureHousehold consumption

MortalityReducing income inequality

SanitationSmoking

Social supportTB treatment

UnemploymentVaccination

Towards a roadmap for implementation of the 2030 Agenda

Roadmap

Consultations with experts

Consultation with civil society

Consultations with UN agenciesOnline review

SCRC

PARTNERSHIPS

Agenda 2030:Health is central to development

Photo: Fotolia

Leaving no one behind

Health for all

Better health for EuropeMore equitable and sustainable